Grizzly Century
Saturday - October 2, 2010
REGISTRATION
FORM (One per entrant,
two for tandems please, copies ok)
Name:__________________________________________________________
Age:____
Street Address: ____________________________________
City: State: Zip:
Contact phone and/or email:
________________________________________
Emergency contact name and phone:
__________________________________
Contact name Phone
number
Which
ride do you wish to enter? (check
one - and Double take if trying it)
O The Griz (100 miles with 80 mile opt
out) ...start 7:00 am
O 100 K (63 miles)...start 7:30 am
O Loop the Lake (24 miles)...start 8:30 am
ENTRY FEES: 100 K and 100 Mile:
Pre-reg Until
9/20/10: $45 single, $85 tandem After
9/20/10: $55
single, $105 tandem
ENTRY
FEES: Loop the Lake
Pre-reg Until
9/20/10: $35 single, $65 tandem After
9/20/10: $45
single, $85 tandem
T-shirt
size [pre-reg riders only!]: Circle one XS S M L XL XXL
Return with check or
money order to: GRIZZLY CENTURY
P.O. Box 475
North Fork, CA 93643
600 rider limit this year !! On-line reg
with signmeup.com to verify acceptance (after 9/20/10).
Additional info or confirmation, Email request to:
grizzlycentury@yahoo.com
WAIVER
All must read and sign at check-in
In consideration of the acceptance of my
application for entry in the Grizzly Century event, I
hereby waive, release and discharge any and all claims for
damages of death, personal injury, or property damage which
I may have, or which may hereafter accrue to me, as a
result of my participation in said event. This release is
intended to discharge in advance the promoters; the
sponsors; the Grizzly Century Committee, its members and
officers; the officials; any involved municipalities
including Bass Lake, North Fork, or Madera County, the USDA
Forest Service; or other public entities and their
respective agents and employees; and other entrants from
and against any and all liability arising out of or
connected in any way with my participation in said event,
though that liability may arise out of negligence or
carelessness on the part of the persons or entities
mentioned above. I further understand that bicycling events
will frequently encounter hazardous conditions such as
large motorized vehicles, rough road surfaces, and steep,
narrow, and winding mountain roads which hold the potential
for accidents and serious personal injury, or activity at
high altitudes and in possible adverse weather conditions.
Mindful of these risks I hereby agree to assume all other
risks and hold harmless all of the persons or entities
mentioned.
I further understand and agree that this release extends to
all claims of every nature and kind whatsoever, known or
unknown, suspected or unsuspected and I hereby expressly
waive any and all right under or in protection of Section
1542 of the Civil Code of California, which provides
verbatim as follows: “S1542, General Release; extend. A
general release does not extend to claims which the
creditor does not know or suspect to exist in his favor at
the time of executing the release, which if known to him
must have materially affected settlement with debtor.”
Signature of entrant:
______________________________________________________________________________
Signature of parent/legal guardian; if entrant is a minor
(under 18 years)
